NPIMap

Organization Active NPI

Avenues of Change

  • Professional Counselor
  • Marietta, GA
National Provider Identifier
1043657075
Registry record updated May 31, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Professional CounselorTaxonomy code 101YP2500X
License
LPC004657 Issued in GA
Legal business name
AVENUES OF CHANGE
Practice address
1568 Cloverdale Dr SE
Marietta, GA 30067-7406
Phone
(770) 713-4574
NPI assigned
May 31, 2013
Last updated
May 31, 2013By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 31, 2013

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Maryann Smolko-Self, 7707134574
Title
Owner/LPC
Phone
(770) 713-4574

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Professional Counselor 101YP2500X LPC004657 GA Primary

Addresses

Primary practice location

1568 Cloverdale Dr SE
Marietta, GA 30067-7406

Mailing address

132 Gallery Court
Acworth, GA 30101
Phone (770) 713-4574

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1369958400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1369958400000",
    "number": "1043657075",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "132 GALLERY COURT",
            "city": "ACWORTH",
            "state": "GA",
            "postal_code": "30101",
            "telephone_number": "770-713-4574"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1568 CLOVERDALE DR SE",
            "city": "MARIETTA",
            "state": "GA",
            "postal_code": "300677406",
            "telephone_number": "770-713-4574"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "AVENUES OF CHANGE",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-05-31",
        "last_updated": "2013-05-31",
        "status": "A",
        "authorized_official_last_name": "SMOLKO-SELF",
        "authorized_official_first_name": "MARYANN",
        "authorized_official_title_or_position": "OWNER/LPC",
        "authorized_official_telephone_number": "770-713-4574",
        "authorized_official_credential": "7707134574"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "GA",
            "license": "LPC004657",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Marietta, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 31, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.